Don't Force Women to Deliver Vaginally After a Loss

Dear readers, when we talk about silent birth (the German term for delivering a baby who has already died), we have to keep in mind how vulnerable the women going through it are. When a baby dies in the womb, mothers in Germany are generally advised to deliver vaginally. Not every woman wants that. One of our readers, Alexandra Noll, felt almost cornered and stripped of her autonomy. Now she's speaking up for more self-determination after pregnancy loss.

Alexandra, you started the new year pregnant. Tell us how the pregnancy went at first.

Physically, I wasn't doing very well, unfortunately. I had serious circulation problems, developed an overactive thyroid, and was nauseous. I could hardly wait to get through the first 12 weeks, because the risks drop significantly after that.

At 11 weeks, I found out I was pregnant with twins, and specifically monochorionic-monoamniotic (mono-mono) twins. That's the rarest and highest-risk form of identical twins. Because of the risks, my twins were going to be delivered by C-section at 32 weeks, which is standard for this kind of pregnancy.

On March 20, 2026, you lost your twins, 13 weeks before they would have been born. How and where did you find out?

At a routine checkup with my OB-GYN. I hadn't had any other symptoms and wasn't expecting it. The ultrasound showed that both little hearts had stopped beating.

What did you feel in that moment?

I was devastated and could hardly believe it. I hoped it was a nightmare and that I'd wake up any second. But unfortunately, it wasn't. I was unbelievably sad.

At the hospital, the doctors recommended a silent birth, meaning you would deliver your babies vaginally. Was that something you could consider?

My OB-GYN sent me to the hospital, and I didn't know what to expect there. When they told me they would induce labor and that I'd deliver my babies vaginally, even though they had already died, it was another shock. I said I didn't want that.

The thinking is that it can help with grieving to consciously go through those last moments with your child, or in your case, your children. Did the hospital staff explain it that way to you?

Yes. I was told it would be the gentlest option for my body and that a silent birth would help all women process their grief. But that didn't add up for me, because everyone grieves differently.

That's the part that stings: in this desperate situation, you felt like nobody took your wishes seriously at all…

I was told a silent birth was the only option. I was lied to, and they tried to get me to agree through fear and pressure. I did research online and found out there's another way, and in the end, that's what I chose. It was the right call, for my body, for my mental health, and for working through my grief.

What was that other way?

The procedure is called a D&E (dilation and evacuation, a suction procedure or vacuum aspiration), and in the Netherlands it's performed up to 22 weeks of pregnancy. There it's a routine procedure, and it's considered very low-risk, even compared to a silent birth.

It was done under general anesthesia and took 20 minutes, and I was able to leave the clinic an hour later. I had no pain, no injuries, and no side effects. I could go right back to doing everything. My health insurance covered the cost of the procedure in full, except for a €50 processing fee.

Have you talked with other women who felt the same way?

I've been to several grief support groups. Many women also described being talked down to and pressured. They had no choice. Women are often told, wrongly, that the birth will be painless because of the generous pain medication. There were some women for whom a silent birth really did help with grieving, but for most it was more of a traumatic experience, and if they'd known about the procedure, they would have chosen it too.

Since the body isn't ready for birth yet, the process can take several days and is started with medication. That makes the contractions different from natural labor, and sometimes a D&C (curettage) under general anesthesia is needed afterward, because bits of tissue can be left behind.

My personal opinion: I think it's cruel to put women through this against their will after such a terrible loss and to present a silent birth as the only and best way.

You now want to advocate for more self-determination in the delivery room...

Yes. I want other women to have a choice, I want them to be better informed, and I want something to change in Germany, because what happened to me at the hospital isn't the exception, unfortunately. It's the rule. After 22 weeks, a C-section shouldn't be completely off the table, even though the risks are higher than with a silent birth.

Once a woman has been properly informed, she should get to decide for herself whether she's willing to take on the higher risks. I hope I can accomplish something so that women get a say over their own bodies.

How exactly do you plan to do that?

By talking about it and sharing my experience as much as I can. I've spoken with the doctors from the hospital and told them how the procedure works. I've also reached out to several pregnancy counseling centers and found support for what I'm trying to do there.

I've written to journalists and podcasters, and I've contacted organizations like “Doctors for Choice Germany” and “Gerechte Geburt” (“Fair Birth”), two German advocacy groups. Among other things, they're working to make the D&E a standard procedure in Germany too.

A complaint is currently pending before Germany's Federal Constitutional Court, arguing that women's right to have a say in their own care is being violated, and my account will be part of it. Since the procedure costs considerably less than a silent birth, I also informed the KBV (Kassenärztliche Bundesvereinigung, the national association of physicians in Germany's public health insurance system).

How are you doing today, three months after the loss?

Much better than at the beginning. The grief comes in waves, but the waves are getting weaker. I'm learning to live with it, but I think the feeling that something is missing will stay.

What would you like to say to other parents who have experienced a pregnancy loss?

Give yourselves time to grieve. It will get better.

To the women, I'd like to say: please, don't blame yourselves. Unfortunately, almost all women seem to do it, but it almost never has anything to do with the mother. And please don't let anyone push you into anything you absolutely don't want. There are always other ways.